The vaping conundrum – RACGP



One affected person’s journey exemplifies the tough path GPs chart when serving to folks stop, writes Dr Hester Wilson.

For some folks, resembling extremely dependent people who smoke, e-cigarettes can have a hurt minimisation position.

Governments do fairly like making selections that will have an effect on us and our sufferers with out asking.


If you don’t know already, as of 1 October 2021, folks have now not been in a position to import liquid nicotine for vaping through e-cigarettes into Australia.


Now, to legally acquire liquid nicotine they want a prescription from us, their GP.


Of course, there are considerations about vaping. I get it – we don’t know the long-term dangers and I’d love all my sufferers to be nicotine and tobacco free. But jeez, these legal guidelines put us as prescribers in a difficult place.


As it stands, we’re being requested to prescribe an ‘unapproved’ product, for which safety, efficacy and quality has not been established’.


We don’t need folks beginning e-cigarettes di novo and we don’t desire a era of younger folks depending on this product; as well being practitioners, we wish our sufferers to quit smoking, as we all know the excellent advantages of this.


For what it’s price, I don’t wish to get into an argument in regards to the execs and cons of e-cigarettes.


Some of our colleagues are very supportive and others strongly object to the concept that folks have entry to this substance. I additionally know that by writing this text I’ll get hate mail.


And I’ve received to say I actually dislike the thought of corporations taking advantage of the addictive properties of a substance that retains folks utilizing it. This just isn’t free alternative.


But it’s also true that for some folks – extremely dependent people who smoke – e-cigarettes have a hurt minimisation position.


So, I’ve taken a fatalistic method to the modifications. The Federal Government have put them by, there’s no level whinging.


Instead, I nonetheless see this as a chance to help a gaggle of people that have a lot to realize from stopping smoking, to get the assist they want to do that.


Which brings me to Sam*, who got here to see me for assist to get off hashish, tobacco, and e-cigarettes.


Sam’s plan is to cease the whole lot fully, however that is tough for her. She has extreme nervousness and social phobia, and whereas she is aware of that stopping the whole lot will assist in the long term, it’s onerous work for her to vary.


For Sam, hashish was probably the most urgent challenge because it made her really feel paranoid and a-motivated.


We labored on that first and she or he is now three months publish final hashish use. This is an excellent achievement for Sam. Problem is, stopping the hashish led to extend in tobacco use. To lower this, Sam elevated e-cigarette use.


At this level Sam was smoking 3–4 cigarettes a day and inhaling this small variety of cigarettes deeply, which suggests she was getting most nicotine out of the few cigarettes she smoked.


Sam was additionally involved in regards to the excessive stage of e-cigarette nicotine use, notably as she feels it interfered together with her sleep, which isn’t nice at the very best of instances.


We talked about pharmacological choices. A BMJ paper in 2019 steered that varenicline may need a job for serving to folks to cease twin use of tobacco and e-cigarettes, whereas one other discovered that nicotine alternative remedy (NRT) and vaping can help smoking cessation.


Sam determined to strive a 25 mg/16-hour NRT patch to see if this might change the extent of tobacco and e-cigarette use and hopefully not have an effect on her sleep.


I additionally steered counselling to assist deal with her nervousness and social phobias. She was reluctant to undertake this, saying ‘I’ve tried that earlier than and it didn’t assist’ however with some encouragement on my half determined to provide it one other go.


This time round she mentioned the counselling helped, saying ‘the counsellor explained a lot and has helped me learn skills to manage my anxiety’ and she or he was in a position to cease all tobacco and drop the liquid nicotine use by two-thirds.


Her subsequent step is to cease e-cigarettes fully. Sam has been acquiring nicotine liquid ‘under the counter’ for the reason that modifications to the regulation.


To my thoughts, an e-cigarette prescription is short-term on the street to Sam ceasing all nicotine containing merchandise and I ponder what different drugs we’d use to assist her to do that. If we use NRT or varenicline to assist her cease e-cigarette use, this will probably be off-label prescribing and subsequently not obtainable on PBS. So, there are many unknowns and concerns for her and I to debate.


I additionally don’t know if NRT and/or varenicline may assist her stop e-cigarettes. Likewise, I don’t know if Sam will cease e-cigarettes fully.


What I do know is that I’m dedicated to aiding Sam to have the very best final result doable and we’ll work on this collectively in coming months.


That could embrace prescribing liquid nicotine for her e-cigarettes as a part of a complete evaluation and plan that takes into consideration the distinctive scenario and threat profile for Sam.


She deserves that diploma of assist and remedy.


More data is on the market through the TGA and RACGP medical tips.


*Sam’s title has been modified to guard her privateness.


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